Addiction and Opiates

Addiction and Opiates CHAPTER 1 METHOD AND PROBLEM
simply not theories at all.
The attempt to identify causal relationships and the assumption that such relationships can be found dictate that all
relevant and available evidence, including the results of statistical studies, be taken into consideration. In particular,
this methodological stance requires intensive, exhaustive probing of individual cases and comparison of certain crucial
types of cases. Thus, when it was noted that some non addicts receive drugs regularly for long periods of time in
hospitals without becoming addicts, I was compelled to compare them with addicts in order to isolate and describe the
causal processes which were present in the cases of addiction and absent among the non-addicted hospital patients. No
tabulations were necessary in making this comparison because it was assumed that the essential causal process of
addiction would be found in all cases of addiction and that it would not be found in any case of non-addiction.
The addicts who were interviewed contributed very unequally to the final theoretical formulation. As already indicated,
some were not seen often enough. Others were inarticulate or lacked the necessary intelligence or interest to provide
coherent accounts of their initial experiences with drugs. Many who were interviewed in the later stages of the
investigation provided data of relatively little theoretical import because the information they gave followed a pattern
made familiar by earlier cases without adding new elements or posing new problems. Only a relatively small
proportion of the addicts interviewed, consisting mainly of intelligent, articulate, experienced, and self-observant users,
made important contributions to the formulation of the theory. Some of these crucial cases forced the abandonment of
provisional hypotheses that had been entertained up to the time they were encountered. Others seemed to bring out in a
striking and obvious way the nature of the process in which addiction is established. This was because they were
departures from the standard and familiar pattern, presenting combinations of circumstances and conditions of the type
which one would wish to have in an experimental test of the theory. Aft& familiarity with the general characteristics
of the addict's behavior bad been acquired from the initial conversations with users, the subsequent progress of the
study seemed to depend upon the analysis of a series of crucial cases which led to successive revisions of the guiding
ideas of the study and to broader perceptions of the logical implications and ramifications of these ideas. As the
analysis progressed the various aspects of addiction behavior, which had at first seemed to be isolated, discrete bits of
information or even paradoxical in nature, fell into place to form integral parts of what eventually seemed to me to be
a consistent and logical whole.
The literature of addiction is highly repetitive, sometimes unreliable, and often based on misinformation. In the later
stages of the study, however, it probably became my most important source of data. The interviews with addicts and
observations of them provided standards for judging the literature and enabled me to understand the sources of error
and distortion. The evidence available in books and articles served the vital function of providing a broad, world-wide
perspective, limited by neither space nor time. Without such a perspective it would have been easy to fall into the error
of taking the part for the whole, that is, of assuming that a particular manifestation or form of addiction limited to a
particular time or place was the prototype of all addiction. Thus, no general theory of opiate addiction can be based on
effects which are produced only when heroin is injected intravenously, as it usually is at present in this country, since
opiate addiction existed many thousands of years before heroin or the intravenous method of injection were known.
The strategy of the research was one of focusing on a strictly limited and specific problem, analyzing it as exhaustively
as possible, and leaving out of consideration a great many other matters that might be of interest and significance in
connection with other types of theories or interests.
This study, it will be observed, is not a study in motivation and therefore does not propose an explanation of addiction
in terms of the motives or purposes that people have for trying drugs. It began as a search for the experience or process
in which addiction is invariably generated, without any prejudgments concerning the motivation question. As it
progressed it seemed evident that no general theory of addiction in terms of motives was possible. This was because:
(1) hospital patients sometimes become addicted when doctors prescribe drugs for them without the patient ever
voluntarily administering the drug to himself; (2) motives or verbal rationalizations of drug users vary widely from
person to person, from culture to culture, and from time to time, and they are often contradictory and inconsistent; and
(3) while initial use of the drug is often but not always voluntary, non addicts are rarely motivated to become addicts,
but are rather trapped by the drug, often unwittingly or against their wills. As will be indicated later, the initial effects
of drugs upon the beginner are not at all comparable to the effects of the same drug upon the habitual user, and, by the
same token, explaining the first trial is a separate and distinct problem from that of accounting for addiction.
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